In 1942, the federal government established the Oak Ridge Reservation (ORR)
in Anderson and Roane counties in Tennessee as part of the Manhattan Project
to research, develop, and produce special nuclear materials for nuclear weapons.
Four facilities were built at that time. The Y-12 plant, the K-25 site, and
the S-50 site were created to enrich uranium. The X-10 site was created to demonstrate
processes for producing and separating plutonium. Since the end of World War
II, the role of the ORR (Y-12 plant, K-25 site, and X-10 site) broadened widely
to include a variety of nuclear research and production projects vital to national
security.

In 1989, the ORR was added to the U.S. Environmental Protection Agency's (EPA's)National Priorities List because, over the years, the ORR operations have generated
a variety of radioactive and nonradioactive wastes that are present in old waste
sites or have been released into the environment. The U.S. Department of Energy
is conducting cleanup activities at the ORR under a Federal Facility Agreement
with EPA and the Tennessee Department of Environment and Conservation. These
agencies are working together to investigate and take remedial action on hazardous
waste from past and present activities at the site.

For the last 10 years, the Agency for Toxic Substances and Disease Registry
(ATSDR) has responded to requests and addressed health concerns of community
members, civic organizations, and other government agencies by working extensively
to determine whether levels of environmental contamination at and near the ORR
present a public health hazard to communities surrounding the ORR. During this
time, ATSDR has identified and evaluated several public health issues and has
worked closely with many parties. ATSDR is the principal federal public health
agency charged with evaluating human health effects of exposure to hazardous
substances in the environment. While the Tennessee Department of Health (TDOH)
conducted the Oak Ridge Health Studies to evaluate whether off-site populations
have been exposed in the past, ATSDR's activities focused on current public
health issues related to Superfund cleanup activities at the site. Prior to
this public health assessment, ATSDR addressed current public health issues
related to two off-site areas affected by ORR operationsthe East Fork
Poplar Creek area and the Watts Bar Reservoir area.

During Phase I and Phase II of the Oak Ridge Health Studies, the TDOH conducted
extensive reviews and screening analyses of the available information and identified
four hazardous substances that may have been responsible for adverse health
effects: radionuclides from White Oak Creek, iodine, mercury, and polychlorinated
biphenyls (PCBs). In addition to the dose reconstruction studies on these four
substances, the TDOH conducted additional screening analyses for releases of
uranium, radionuclides, and several other toxic substances.

To expand upon the efforts of the TDOHnot duplicate themATSDR scientists
conducted a review and a screening analysis of the department's Phase I and
Phase II screening-level evaluation of past exposure (1944-1990) to identify
contaminants of concern for further evaluation. Based on this review, ATSDR
scientists are conducting public health assessments on the release of iodine
131, Y-12 mercury releases, PCBs, radionuclides from White Oak Creek, Y-12 uranium
releases, K-25 uranium and fluoride releases, and other topics such as the Toxic
Substances Control Act (TSCA) incinerator and off-site groundwater. In conducting
these public health assessments, ATSDR scientists are evaluating and analyzing
the information, data, and findings from previous studies and investigations
to assess the public health implications of past and current exposure. The public
health assessment is the primary public health process ATSDR uses to:

Identify populations off the site who may have been exposed to hazardous substances at levels of health concern.

ATSDR scientists will also conduct a screening analysis of all available environmental
sampling data from 1990 to the present to determine whether additional contaminants
of concern need to be addressed.

This public health assessment evaluates the releases of uranium from the Y-12
plant; assesses past and current uranium exposure to residents living near the
ORR, including the residents of the Scarboro community (the reference community);
addresses the community health concerns and issues associated with the uranium
releases from the Y-12 plant; and, where possible, considers health outcome
data that measure health effects associated with exposure to uranium or characterize
the health status of a group of exposed people. This document does not address
the release of other contaminants of concern such as mercury, iodine 131, PCBs,
uranium from the K-25 facility, and fluorides, nor does it address exposures
to those contaminants. ATSDR will evaluate these contaminants and other topics
in separate public health assessments.

The 825-acre Y-12 plant, now called the Y-12 National Security Complex, is
located in Bear Creek Valley and is bordered by Chestnut Ridge and Pine Ridge.
The Y-12 plant was used in the 1940s to electromagnetically enrich uranium.
In 1952, the facility was converted to enrich lithium-6 using a column-exchange
process and to fabricate components for thermonuclear weapons using high-precision
machining and other specialized processes. In 1992, after the Cold War ended,
Y-12's mission was curtailed, and the plant is currently used for weapons disassembly
and weapon renovation operations. The National Nuclear Security Administration
currently uses the Y-12 National Security Complex as the primary storage site
for highly enriched uranium. While operational levels have increased since 1992,
the total operations have not approached the levels experienced before the 1990s.

The Y-12 plant is about 2 miles south of downtown Oak Ridge. It is separated
from the main residential areas of Oak Ridge by Pine Ridge, a ridge that rises
to about 300 feet above the valley floor. In 1942, the city of Oak Ridge was
established for the 13,000 persons who were expected to work at the ORR. The
population peaked at 75,000 in 1945 and decreased to 30,229 in 1950. Since 1959,
when the city of Oak Ridge became self-governing, the Oak Ridge population has
been approximately 27,000. The Scarboro community is a residential area within
the city of Oak Ridge, about a half mile from the Y-12 plant, and is separated
from the Y-12 plant by Pine Ridge. Scarboro was established in 1950 to provide
single-family homes, duplexes, apartments, and an elementary school to African-American
Oak Ridge residents. Scarboro remains predominantly African-American and has
a population of approximately 300 persons.

The meteorological data indicates that the predominant wind directions at the
Y-12 plant are southwest and northeast, generally up and down Bear Creek Valley,
between Pine Ridge and Chestnut Ridge, with limited winds crossing over the
ridges. Therefore, most of the uranium would deposit up and down Bear Creek
Valley and Union Valley. No one lives in these valleys. The city of Oak Ridge
is the only established community where people resided during the years of uranium
releases that could have been impacted by Y-12 uranium releases. In this public
health assessment, the Scarboro community is used as a reference location that
represents the city of Oak Ridge.

During Phase II of the Oak Ridge Health Studies, the TDOH identified Scarboro
as a reference location using air dispersion modeling to estimate average ground-level
air concentrations at locations surrounding the reservation. According to the
modeling results, Scarboro was the off-site population likely to receive the
highest exposures to past releases from the Y-12 plant. The Task 6 report stated
that "while other potentially exposed communities were considered in the
selection process, the reference locations [Scarboro] represent residents who
lived closest to the ORR facilities and would have received the highest exposures
from past uranium releases...Scarboro is the most suitable for screening
both a maximally and typically exposed individual."

Past Exposure

ATSDR evaluated both radiation and chemical aspects of past uranium exposure.
ATSDR concluded that past off-site exposure to uranium from Y-12 is not a public
health hazard. Neither the total radiation dose nor the chemical ingestion and
inhalation doses from off-site exposure to uranium released from the Y-12 plant
in the past would have caused harmful health effects.

To evaluate past exposure to uranium releases from the Y-12 plant, ATSDR primarily
relied on data generated during Task 6 of the TDOH's Reports of the Oak Ridge
Dose Reconstruction, Uranium Releases from the Oak Ridge Reservationa
Review of the Quality of Historical Effluent Monitoring Data and a Screening
Evaluation of Potential Off-Site Exposures (referred to as the "Task 6 report").
The city of Oak Ridge is the only established community adjacent to ORR that
could have been impacted by Y-12 uranium releases. The Scarboro community was
selected as the reference population after air dispersion modeling indicated
that its residents were expected to have received the highest exposures. The
Scarboro community, located in the city of Oak Ridge, is a representative community;
therefore, the conclusions are valid for the people living near the Y-12 Plant,
including the city of Oak Ridge.

To evaluate cancer health effects from past radiation exposure, ATSDR adjusted
the total uranium radiation doses reported in the Task 6 report to be equivalent
to a 70-year exposure1. The total radiation dose received by the reference population,
the Scarboro community, from all air, surface water, and soil exposure pathways
(a committed effective dose [CEDE] of 155 millirem [mrem] over 70 years) is
well below (32 times less than) the ATSDR radiogenic cancer comparison value
of 5,000 mrem over 70 years. This radiogenic cancer comparison value assumes
that the entire radiation dose (a 70-year dose, in this case) from the intake
of uranium is received in the first year following the intake. Doses below this
value are not expected to result in adverse health effects. Therefore, ATSDR
does not expect carcinogenic health effects to have occurred from exposure to
uranium in the past.

To evaluate noncancer health effects from the total past uranium radiation
dose received by the Scarboro community (a CEDE of 155 mrem over 70 years),
ATSDR divided that dose by 70 years to approximate a value of 2.2 mrem as the
radiation dose for the first year. This approximate dose is well below (45 times
less than) the ATSDR minimum risk level (MRL) of 100 mrem/year for chronic ionizing
radiation exposure. ATSDR believes that the MRL itself is below levels that
might cause adverse health effects in people most sensitive to such effects,
and therefore does not expect noncancer health effects to have occurred from
radiation doses received from past Y-12 uranium releases.

To evaluate potential chemical health effects from past uranium exposure, ATSDR
estimated exposure through the air pathway and compared the yearly air concentrations
in the Scarboro community to ATSDR's inhalation MRL for uranium. Yearly estimated
average air concentrations of uranium in Scarboro ranged from 2.1 × 10-8
to 6.0 × 10-5 milligrams per cubic meter (mg/m3).
These air concentrations are less than 1% of the inhalation MRL for chemical
effects (8 × 10-3 mg/m3). ATSDR also estimated exposure
to uranium through the soil and surface water pathways and compared the resulting
doses to levels associated with known health effects. Yearly estimated doses
from exposure to uranium via all soil ingestion and surface water exposure pathways
ranged from 2.7 × 10-5 to 1.3 × 10-2 milligrams
per kilogram per day (mg/kg/day). All doses are less than the dose (5 ×
10-2 mg/kg/day) at which health effects (renal toxicity) have been
observed in rabbits, the mammalian species most sensitive to uranium kidney
toxicity. Therefore, ATSDR does not expect that residents were exposed in the
past to levels of uranium that would cause harmful chemical effects.

Additionally, it should be noted that several levels of conservatism were built
into this evaluation of past exposures. The values that ATSDR relied on to evaluate
past exposures (those from the Task 6 report) came from a screening evaluation
that routinely and appropriately used conservative and protective assumptions
and approaches. This led to an overestimation of concentrations and doses. Even
using these conservative overestimations of concentrations and doses, persons
in the reference community (Scarboro) and other communities near the Y-12 plant
were exposed to levels of uranium that are below health concern.

Current Exposure

ATSDR evaluated both radiation and chemical aspects of current uranium exposure.
Based on our review of data collected in and around the Scarboro community,
and as compared to background and distant areas, ATSDR has determined that exposure
to the current levels of uranium would not cause harmful health effects.

To assess current exposure to uranium releases from the Y-12 plant, ATSDR evaluated
air data from monitoring stations, surface water sampling from East Fork Poplar
Creek and Scarboro, recent soil sampling from the Scarboro community, samples
of garden crops from Scarboro, and garden crop samples from outlying areas.
Most of the data were supplied by the Oak Ridge Environmental Information System
(OREIS), a centralized, standardized, quality-assured, and configuration-controlled
environmental data management system that is publicly available. ATSDR also
supplemented the evaluation with data from the Scarboro Community Environmental
Study by the Florida Agricultural and Mechanical University (FAMU) and the
September 2001 Sampling Report for the Scarboro Community by EPA. ATSDR
evaluated the following pathways: ingestion of soil, ingestion of foods, ingestion
of water from nearby creeks, inhalation of air, and external exposure from uranium
in soils.

To evaluate the cancer effects of current exposure to radiation from uranium,
ATSDR assessed the radiation dose received by the reference populationthe
Scarboro communitythrough exposure to uranium ingested in soil and vegetables
and inhaled in air. That dose (0.216 mrem) is well below (23,000 times less
than) the radiogenic cancer comparison value of 5,000 mrem over 70 years. ATSDR
derived this CEDE from the intake of uranium, making the assumption that the
entire dose (a 70-year dose, in this case) is received in the first year following
the intake. Doses below this value are not expected to have adverse health effects.
Therefore, ATSDR does not expect harmful radiation effects to occur from the
exposure to uranium that is occurring currently.

ATSDR also evaluated noncancer health effects from the total current uranium
radiation dose (a CEDE of 0.216 mrem over 70 years) received by the Scarboro
community, ATSDR divided the CEDE of 0.216 mrem, which is based on 70 years
of exposure, by 70 years to approximate a value of 0.003 mrem as the radiation
dose for the first year. This approximate dose of 0.003 mrem is well below (33,000
times lower than) the ATSDR minimum risk level (MRL) of 100 mrem/year for chronic
ionizing radiation exposure. ATSDR believes the chronic ionizing radiation received
by communities near the Y-12 plant from uranium exposure is below levels that
might cause adverse health effects in people most sensitive to such effects,
and therefore does not expect noncancer health effects to occur from current
radiation doses.

In addition, ATSDR compared the soil radioactivity concentrations in the reference
location (Scarboro) with typical concentrations found in nature and from background
samples collected from uncontaminated areas around the reservation. This evaluation
showed that the soil radioactivity concentrations in Scarboro were indistinguishable
from natural and background concentrations.

To evaluate potential chemical health effects, ATSDR estimated exposure through
the air pathway and compared the yearly air concentrations in the Scarboro community
to ATSDR's inhalation MRL. Average uranium air concentrations from monitoring
stations near the ORR (ranging from 3.7 × 10-11 to 1.4 ×
10-10 mg/m3), including station 46 in Scarboro (5.4 ×
10-11), are several orders of magnitude below (over a million times
less than) the intermediate-duration MRL of 8 × 10-3 mg/m3
for insoluble forms of uranium. ATSDR also estimated exposure to uranium through
the soil and surface water pathways and compared the resulting doses to ATSDR's
screening values: the environmental media evaluation guide (EMEG) and the oral
MRL. The concentrations of uranium found in the surface water from off-site
areas of East Fork Poplar Creek (0.197 and 12.8 micrograms per liter, or µg/L)
are below ATSDR's EMEG of 20 µg/L. Additionally, the estimated doses from
ingestion of uranium in soil (ranging from 2.07 × 10-6 to 1.4
× 10-5 mg/kg/day) and food (3.0 × 10-5 and
3.9 × 10-5 mg/kg/day in the Scarboro community) were well below
the oral MRL of 2 × 10-3 mg/kg/day. Even if the exposures from
the two pathways are combined, the resulting dose is still lower than the MRL.
For example, if the highest dose following ingestion of soil is added to the
total intake from ingestion of vegetables grown in Scarboro, the total ingestion
dose is 5.3 × 10-5 mg/kg/day, which is about two orders of magnitude below
the MRL. Therefore, ATSDR believes that residents are currently being exposed
to levels of uranium that would not cause harmful chemical effects.

II. BACKGROUND

II.A. Site Description

In 1942, the federal government established the 58,000-acre Oak Ridge Reservation
(ORR), located in Anderson and Roane counties in Tennessee, as part of the Manhattan
Project to research, develop, and produce special nuclear materials for nuclear
weapons (ChemRisk 1993a; TDOH 2000). Four facilities were built. The Y-12 plant,
the K-25 site, and the S-50 site were created to enrich uranium (U), and the
X-10 site was created to demonstrate processes for producing and separating
plutonium (TDOH 2000)2. The Clinch River forms the southern and western boundaries
of the reservation, and most of the property is within the Oak Ridge city limits
(EUWG 1998). Please see Figure 1 for the location of the ORR.

The Y-12 plant is located in the eastern end of Bear Creek Valley. It is bordered
on the south by Chestnut Ridge and on the north by Bear Creek Road and Pine
Ridge (ChemRisk 1999). The main Y-12 production area is about 0.6 miles wide
and 3.2 miles long; the area contains roughly 240 principal buildings, of which
about 18 were directly involved with processing and/or storage of uranium compounds
(Patton 1963; UCC-ND 1983 as cited in ChemRisk 1999). The 825-acre Y-12 plant
is located within the corporate limits of the city of Oak Ridge, about 2 miles
south of downtown (ChemRisk 1999). It is less than a half mile from the Scarboro
community, but Pine Ridge (which rises to about 300 feet above the valley floor)
separates the Y-12 plant from the main residential areas of Oak Ridge (TDOH
2000).

Since the early 1940s, the ORR processed large quantities of uranium, enriching
it into uranium 235 for the production of nuclear weapon components and for
use in commercial nuclear reactors and various research and development projects
(ChemRisk 1993a as cited in ChemRisk 1999).

From 1944 to 1947, the Y-12 plant was used to electromagnetically enrich uranium,
but in 1952 the facilities were converted to fabricate nuclear weapon components
(ChemRisk 1999). During the Cold War, a column-exchange process (Colex) that
used large quantities of mercury as an extraction solvent to enrich lithium
in lithium 6 was built and operated (TDOH 2000). At the end of the Cold War,
the Y-12 missions were curtailed. In 1992 the major focus of the Y-12 plant
was the remanufacture of nuclear weapon components and the dismantlement and
storage of strategic nuclear materials from retired nuclear weapons systems.
In October 2000, oversight of the Y-12 plant was changed from the U.S. Department
of Energy (DOE) Oak Ridge Operations to the DOE National Nuclear Security Administration.
The National Nuclear Security Administration currently uses the Y-12 National
Security Complex as the primary storage site for highly enriched uranium. While
operational levels have increased since 1992, the total operations have not
approached the levels experienced prior to the 1990s. See Figure 2 for a time
line of the major processes at the Y-12 plant.

Because
ORR operations have generated a variety of radioactive and nonradioactive wastes,
the ORR was added to the National Priorities List (NPL) in 1989 (EPA 2002b).
DOE is conducting cleanup activities at the ORR under a Federal Facility Agreement,
which is an Interagency Agreement with the U.S. Environmental Protection Agency
(EPA) and the Tennessee Department of Environment and Conservation (TDEC). This
agreement allows for input from the public. These parties are working together
to investigate and take remedial action on hazardous waste from past and present
activities at the site. DOE is integrating required measures from the Resource
Conservation and Recovery Act (RCRA) with response actions under the Comprehensive
Environmental Response, Compensation, and Liability Act (CERCLA). See Figure
2 for a time line of surface water, biota, sediment, soil, air, and drinking
water environmental monitoring data related to activities at the Y-12 plant.

Contaminants such as uranium and mercury are present in old waste sites, which
occupy 5% to 10% of the ORR. The abundant rainfall (an annual average of 55
inches) and high water tables (for example, 0 to 20 feet below the surface)
on the reservation contribute to leaching of these contaminants, resulting in
contaminated soil, surface water, sediments, and groundwater (EUWG 1998).

Since 1986 (when initial cleanup activities commenced), DOE has initiated approximately
50 response actions under the Federal Facility Agreement that address contamination
and disposal issues on the reservation. In order to consolidate investigation
and remediation of environmental contamination, the contaminated areas were
divided into five large tracts of land, generally associated with the major
hydrologic watersheds (EUWG 1998). The following remedial actions pertain to
the Y-12 plant specifically:

Upper East Fork Poplar Creek (EFPC) is located entirely on the site.
It originates from a spring beneath the Y-12 plant; initially confined to
a manmade channel, it flows through the Y-12 plant along Bear Creek Valley.
A Record of Decision (ROD) was negotiated between EPA, TDEC, and DOE that
selected a number of different source control remedies to control the influx
of mercury from the Y-12 plant into Upper EFPC. The major actions are the
hydraulic isolation of contaminated soils in the West End Mercury Area, the
treatment of the discharge of groundwater into Upper EFPC at Outfall 51, and
the removal of contaminated sediments from Upper EFPC and Lake Reality. The
goal is to restore surface water in Upper EFPC to human health recreational
risk-based values at Station 17, which is where Upper EFPC flows into Lower
EFPC (DOE 2002b; EPA 2002a).

Lower East Fork Poplar Creek (EFPC) flows north from the Y-12 plant
off site into the city of Oak Ridge through a gap in Pine Ridge. Lower EFPC
flows through residential and business sections of Oak Ridge to join Poplar
Creek, which flows to the Clinch River. Lower EFPC was contaminated by releases
of mercury and other contaminants, starting in the early 1950s. The remedial
investigation/feasibility study (RI/FS) for Lower EFPC was completed in 1994.
The ROD was approved in September 1995, and remediation field activities began
in June 1996 (ATSDR et al. 2000). The Remedial Investigation and Proposed
Plan ultimately led to the decision to excavate floodplain soils having mercury
levels higher than 400 parts per million (ppm), sampling to ensure that all
mercury above this level had been removed, and periodic monitoring (DOE 2001).
The Agency for Toxic Substances and Disease Registry (ATSDR) evaluated the
public health impacts of the 400 ppm cleanup level and concluded that it was
protective of public health (ATSDR 1996). During the remediation, several
pockets of radiologically contaminated soils (>250 counts per minute gross
beta-gamma) were located, excavated, placed in containers, and stored at the
East Tennessee Technology Park (DOE 2002a).

Bear Creek Valley is located on the reservation. A remedial decision
for part of Bear Creek Valley was recently signed. To prevent further leaching
of uranium to groundwater and surface water, approximately 80,000 cubic yards
of contaminated soil and debris was removed from the Boneyard/Burnyard and
disposed of in an on-site CERCLA waste disposal facility and a capped aboveground
disposal area (DOE 2003). In addition, shallow groundwater near the S-3 ponds
and the burial grounds will be treated through in situ reactive trenches
(C.J. Enterprises 2001).

Further detailed information on remedial and regulatory information at the
ORR can be found in Oak Ridge Health Studies Phase 1 Report: Volume IIPart
ADose Reconstruction Feasibility Study, Tasks 1 & 2, A Summary of
Historical Activities on the Oak Ridge Reservation With Emphasis on Information
Concerning Off-Site Emission of Hazardous Material (ChemRisk 1993a); Public
Involvement Plan for CERCLA Activities at the U.S. Department of Energy, Oak
Ridge Reservation (C.J. Enterprises 2001); and Oak Ridge Reservation
Annual Site Reports.

II.D. Land Use and Natural Resources

The ORR currently has about 35,000 acres. The three major DOE installationsthe
East Tennessee Technology Park (formerly the K-25 site and the Oak Ridge Gaseous
Diffusion Plant), Oak Ridge National Laboratory (formerly the X-10 site), and
the Y-12 National Security Complex (formerly the Y-12 plant)occupy about
30% of that acreage. The remaining 70% was established as a National Environmental
Research Park in 1980, to provide protected land for environmental science research
and education and to demonstrate that energy technology development can coexist
with a quality environment. Large portions of the reservation, much of which
had formerly been cleared for farmland, have grown into full forests over the
past several decades. Some of this land includes areas known as "deep forest"
that contain ecologically significant flora and fauna; portions of ORR are considered
to be biologically rich (SAIC 2002).

The ORR also included an area set aside for residential, commercial, and support
services. The city of Oak Ridge was created in 1942 to provide housing to the
employees of ORR and was originally controlled by the military (Friday and Turner
2001). The self-governing portion of the city of Oak Ridge comprises about 14,000
acres and contains housing, schools, parks, shops, offices, and industrial areas.
The urban population of Oak Ridge continued to grow over several decades, and
some residential properties are next to the ORR boundary line. Outside the urban
areas, much of the region (about 40%) is still a pattern of farms and small
communities, as it was historically (ChemRisk 1993c).

Public access is restricted at the Y-12 plant, which is located entirely within
the ORR "229 Boundary." Y-12 is "an active production and special
nuclear materials management facility [and so] additional security and access
limitations apply" (DOE 2002b). Out of 1,170 acres in the Upper EFPC area,
800 acres are currently used for industrial purposes. This area includes maintenance
facilities, office space, training facilities, change houses, facilities that
were formerly used by the Oak Ridge National Laboratory Biology Division, waste
management facilities, construction contractor support areas, and a high-security
portion that supports core National Nuclear Security Administration missions
(DOE 2002b).

A number of maps of this area indicate a wide range of land types, including
"types of urban or built up land, agricultural land, rangeland, forestland,
water, and wetlands," and uses that consist of "residential, commercial,
public and semi-public, industrial, transportation, communication and utility,
and extractive (e.g., mining)" (ChemRisk 1993c).

Agriculture (beef and dairy cattle) and forestry had been the two predominant
land uses in the area around ORR; however, both of these uses are currently
declining. For many years, milk was produced, bottled, and distributed locally.
Corn, tobacco, wheat, and soybeans were the major crops grown in the area. Small
game and waterfowl are hunted in the area continuously, and deer are hunted
during certain periods (ChemRisk 1993c). Radiological monitoring is performed
during the annual deer hunts to "provide assurance that harvested animals
do not contain levels of radionuclides which would result in significant internal
exposure to humans consuming meat from the animals" (Teasley 1995).

EFPC originates from within the Y-12 plant boundary, flows through the city
of Oak Ridge for about 12 miles, and ultimately converges with Poplar Creek
near the K-25 facility (DOE 1989). A number of small tributaries flow into the
creek and support some small aquatic life. EFPC is classified by the state of
Tennessee as appropriate for fishing, recreation, irrigation, livestock watering,
and wildlife use (ATSDR 1993a). While people do not use the streams on the reservation,
public access exists downstream from the reservation. The area that Lower EFPC
flows through has many uses, which can be grouped into five categories: residential,
commercial, agricultural, other, and DOE-owned (DOE 1995a). The creek appears
to be too shallow for swimming, although some areas, particularly those near
the confluence with Poplar Creek, are suitable for wading and fishing. TDEC
issued a fishing advisory for EFPC that warns the public to avoid eating fish
from the creek and to avoid contact with the water (ATSDR 1993a).

Groundwater is contaminated throughout much of the on-site Upper EFPC area.
No one, however, is currently using the groundwater in the area where a contaminated
groundwater plume extends past the ORR boundary (i.e., in Union Valley to the
east of ORR) (DOE 2002b). The shallow groundwater along some off-site areas of the Lower EFPC floodplain
contains metals at levels of public health concern; however, this off-site shallow
groundwater is not used for drinking or other domestic purposes.

II.E. Demographics

II.E.1. Oak Ridge

The city of Oak Ridge, Tennessee, was established in Anderson County in 1942,
for the 13,000 persons who were expected to work at the ORR (Friday and Turner
2001). By July 1944, the population of Oak Ridge had increased to 50,000. The
population peaked at 75,000 in 1945 and decreased to 30,229 by 1950 (see Table
1) (Oak Ridge Comprehensive Plan 1988). In 1959, about 14,000 acres within the
city of Oak Ridge became self-governing (ChemRisk 1993c). Almost since its establishment,
the city of Oak Ridge has been the largest population center in the area (ChemRisk
1993c).

From 1940 to 1960, the city of Oak Ridge had a higher proportion of working-age
people and fewer seniors than the rest of Tennessee (ChemRisk 1993c). However,
since 1960, the population of residents over age 35 and over age 55 has increased,
while the population of children under age 16 has declined (Oak Ridge Comprehensive
Plan 1988). The education level of Oak Ridge citizens is dramatically higher
than in surrounding areas; Oak Ridge boasts one of the highest per capita ratios
of Doctors of Philosophy (Ph.D.s) of any city in the United States (Oak Ridge
Comprehensive Plan 1988).

II.E.2. Scarboro

The Scarboro community is located within the city of Oak Ridge, about a half
mile from the Y-12 plant, and is separated from the Y-12 plant by Pine Ridge.
Before 1950, the area was known as the Gamble Valley Trailer Camp, and the population
was predominantly white. In 1950, Scarboro was established to provide single-family
homes, duplexes, apartments, and an elementary school to African-American Oak
Ridge residents (Friday and Turner 2001). To this day, Scarboro remains predominantly
African-American (94%) (Joint Center Summary Number 4).

In the fall of 1999, the Joint Center for Political and Economic Studies conducted
a survey of the broader Scarboro community (Friday and Turner 2001). The staff
identified 380 residences, of which 326 were occupied, and about 266 persons
responded to the survey (82%). The report generated from the survey is one of
the few sources of detailed information available on the Scarboro community
(Friday and Turner 2001). Some of the demographic information resulting from
this survey is presented in the following paragraphs. For additional details,
please see the Scarboro Community Assessment Report (Friday and Turner
2001).

The Scarboro community is aging: the average respondent is almost 53 years
old and only 36% of participating households reported having at least one member
between the ages of 18 and 34 years old. About half of the households reported
having one senior citizen or more, while only 23% of the surveyed households
reported having children. Additionally, 39% of respondents were retired. As
of 1999, the average length of residence in Scarboro was 29 years. However,
many (82%) of the young adult residents (18-30 years old) moved to Scarboro
after 1994 (Friday and Turner 2001).

Figure 3 provides the current demographics for a 1-mile and 3-mile radius of the Y-12 plant.

This section describes the public health activities that pertain to Y-12 uranium
releases. Several additional public health activities that have been conducted
at the ORR by ATSDR, the Tennessee Department of Health (TDOH), and other agencies
are described in Appendix B. See Figure 2 for a time line of public health activities related to the Y-12 plant.

II.F.1. ATSDR

For the last 10 years, ATSDR has addressed the health concerns of community
members, civic organizations, and other government agencies by working extensively
to determine whether levels of environmental contamination at and near the ORR
present a public health hazard. During this time, ATSDR has identified and evaluated
several public health issues and has worked closely with many parties, including
community members, civic organizations, physicians, and several local, state,
and federal environmental and health agencies. While the TDOH conducted the
Oak Ridge Health Studies to evaluate whether off-site populations have experienced
exposures in the past, ATSDR's activities focused on current public
health issues to prevent duplication of the state's efforts. The following paragraphs
highlight major public health activities conducted by ATSDR that pertain to
Y-12 uranium releases.

Exposure Investigations, Health Consultations, and Other Scientific Evaluations.
ATSDR health scientists have addressed current public health issues related
to two areas affected by ORR operationsthe EFPC area and the Watts Bar
Reservoir area. Briefs summarizing both health consultations are provided
in Appendix I

Health Consultation on Y-12 Weapons Plant Chemical Releases Into East Fork
Poplar Creek, April 1993. This health consultation provided DOE with
advice on current public health issues related to past and present chemical
releases into the creek from the Y-12 weapons plant. DOE implemented many
of ATSDR's recommendations before finalizing its remedial investigation
and feasibility study on EFPC. The EFPC Phase IA data evaluated for this
health consultation indicate that the creek's soil, sediment, groundwater,
surface water, air, and fish are contaminated with various chemicals. ATSDR
made the following public health conclusions:

Soil and sediments in certain locations along the EFPC floodplain are contaminated
with levels of mercury that pose a public health concern.

Fish in the creek contain levels of mercury and polychlorinated biphenyls
(PCBs) that pose a moderately increased risk of adverse health effects to people
who eat fish frequently over long periods of time.

Shallow groundwater in a few areas along the EFPC floodplain contains metals
at levels of public health concern; however, this shallow groundwater is not
used for drinking or other domestic purposes.

Other contaminants, including radionuclides found in soil, sediment, surface
water, and fish, were not detected at levels of public health concern.

Health Consultation on the Lower Watts Bar Reservoir, February 1996.
ATSDR concluded that PCBs detected in fish from lower Watts Bar Reservoir
pose a public health concern. Frequent and long-term ingestion of fish from
the reservoir poses a moderately increased risk of cancer and may increase
the possibility of developmental effects in infants whose mothers consume
fish regularly during gestation and while nursing. ATSDR also found that
current levels of contaminants in the reservoir surface water and sediment
were not a public health hazard, and that the reservoir was safe for swimming,
skiing, boating, and other recreational purposes. Additionally, water from
the municipal water systems was safe to drink. ATSDR also reported that
DOE's selected remedial actions would protect public health. These actions
include maintaining the fish consumption advisories; continuing environmental
monitoring; implementing institutional controls to prevent disturbance,
resuspension, removal, or disposal of contaminated sediment; and providing
community and health professional education about the PCB contamination.

Coordination with other parties. Since 1992 and continuing to the present,
ATSDR has consulted regularly with representatives of other parties involved
with the ORR. Specifically, ATSDR has coordinated efforts with TDOH, TDEC,
the National Center for Environmental Health (NCEH), the National Institute
for Occupational Safety and Health (NIOSH), and DOE. This effort led to the
establishment of the Public Health Working Group in 1999, which led to the
establishment of the Oak Ridge Reservation Health Effects Subcommittee (ORRHES).
In addition, ATSDR provided some assistance to TDOH in its study of past public
health issues. ATSDR has also obtained and interpreted studies prepared by
academic institutions, consulting firms, community groups, and other parties.

Oak Ridge Reservation Health Effects Subcommittee. ORRHES was created
to provide a forum for communication and collaboration between citizens and
the agencies that are evaluating public health issues and conducting public
health activities at the ORR. The ORRHES was established in 1999 by ATSDR
and Centers for Disease Control and Prevention (CDC) under the authority of
the Federal Advisory Committee Act (FACA) as a subcommittee of the U.S. Department
of Health and Human Services' Citizens Advisory Committee on Public Health
Service Activities and Research at DOE Sites. The Subcommittee consists of
individuals who represent diverse interests, expertise, backgrounds, and communities,
as well as liaison members from state and federal agencies. To help ensure
citizen participation, meetings of the Subcommittee's work groups are open
to the public and anyone may attend and present ideas and opinions. The Subcommittee
performs the following functions:

Serves as a citizen advisory group to CDC and ATSDR and provides recommendations
on matters related to public health activities and research at the ORR.

Provides an opportunity for citizens to collaborate with agency staff members
and to learn more about the public health assessment process and other public
health activities.

Helps to prioritize the public health issues and community concerns to be
evaluated by ATSDR.

ORRHES Work Groups. The ORRHES may create various work groups to conduct
in-depth exploration of specific issues and present findings to the Subcommittee
for deliberation. Work group meetings are open to all who wish to attend and
participate. The following ORRHES work groups were established:

ATSDR Field Office. In 2001, ATSDR opened a field office in Oak Ridge.
The office was opened to promote collaboration between ATSDR and communities
surrounding the ORR by providing community members with opportunities to become
involved in ATSDR's public health activities at the ORR. The ATSDR field office
is located at 1975 Tulane Avenue, Oak Ridge, Tennessee. ATSDR field office
staff can be contacted by calling 865-220-0295.

Oak Ridge Health Studies. In 1991, DOE and the state of Tennessee entered
into the Tennessee Oversight Agreement, which allowed the TDOH to undertake
a two-phase independent state research project to determine whether past environmental
releases from ORR operations harmed people who lived nearby (ORHASP 1999).

Phase I. Phase I of the Oak Ridge Health Study is a Dose Reconstruction
Feasibility Study. This feasibility study evaluated all past releases of hazardous
substances and operations at the ORR. The objective of the study was to determine
the quantity, quality, and potential usefulness of the available information
and data on these past releases and subsequent exposure pathways. Phase I
of the health studies began in May 1992 and was completed in September 1993.
A brief summarizing the Phase I Feasibility Study is provided in Appendix I.

The findings of the Phase I Dose Reconstruction Feasibility Study indicated
that a significant amount of information was available to reconstruct the past
releases and potential off-site exposure doses for four hazardous substances
that may have been responsible for adverse health effects. These four substances
include (1) radioactive iodine releases associated with radioactive lanthanum
processing at X-10 from 1944 through 1956; (2) mercury releases associated with
lithium separation and enrichment operations at the Y-12 plant from 1955 through
1963; (3) PCBs in fish from EFPC, the Clinch River, and the Watts Bar Reservoir;
and (4) radionuclides from White Oak Creek associated with various chemical
separation activities at X-10 from 1943 through the 1960s.

Phase II (also referred to as the Oak Ridge Dose Reconstruction). Phase
II of the health studies conducted at Oak Ridge began in mid-1994 and was
completed in early 1999. Phase II primarily consisted of a dose reconstruction
study focusing on past releases of radioactive iodine, radionuclides from
White Oak Creek, mercury, and PCBs. In addition to the full dose reconstruction
analyses, the Phase II effort also included additional detailed screening
analyses for releases of uranium and several other toxic substances that had
not been fully characterized in Phase I (a brief in Appendix I summarizes
the Screening-Level Evaluation of Additional Potential Materials of Concern,
Task 7). The significant findings for each of the substances evaluated are
presented in the following paragraphs.

Radioactive iodine releases were associated with radioactive lanthanum processing
at X-10 from 1944 through 1956. Results indicate that children who were born
in the area in the early 1950s and who drank milk produced by cows or goats
living in their yards, had an increased risk of developing thyroid cancer. The
report stated that children living within a 25-mile radius of Oak Ridge were
likely to have had an increased risk of more than 1 in 10,000 of developing
thyroid cancer.

The study evaluated mercury releases associated with lithium separation and
enrichment operations at the Y-12 plant from 1955 through 1963. Results indicate
that depending on their activities, individuals living in the area during the
years that mercury releases were highest (mid-1950s to early 1960s) may have
received annual average doses of mercury exceeding the EPA reference dose.

Additional studies were conducted on PCBs in fish from EFPC, the Clinch River,
and the Watts Bar Reservoir. Preliminary results indicated that individuals
who consumed a large amount of fish from these waters might have received doses
that exceeded the EPA reference dose for PCBs.

Radionuclides associated with various chemical separation activities at the
X-10 site from 1943 through the 1960s were released into White Oak Creek. Eight
radionuclides (cesium 137, ruthenium 106, strontium 90, cobalt 60, cerium 144,
zirconium 95, niobium 95, and iodine 131) deemed more likely to carry significant
risks were studied. The results indicate that the releases caused small increases
in the radiation dose of individuals who consumed fish from the Clinch River
near the mouth of White Oak Creek. The dose reconstruction scientists estimated
that a man who ate up to 130 meals of fish from the mouth of White Oak Creek
every year for 50 years (worst-case scenario) would face an excess cancer risk
ranging from 4 to 350 in 100,000. The risk from eating fish goes down proportionately
for people who eat fewer fish and for people who eat fish caught farther downstream.

Uranium was released from various large-scale uranium operations, primarily
uranium processing and machining operations at the Y-12 plant and uranium enrichment
operations at the K-25 and S-50 plants. Because uranium was not initially given
high priority as a contaminant of concern, a Level II screening assessment for
all uranium releases was performed. Preliminary screening indices were slightly
below the decision guide of one chance in 10,000, which indicated that more
work may be needed to better characterize uranium releases and possible heath
risk. A brief summarizing the Task 6 report is provided in Appendix I.

The Oak Ridge Health Agreement Steering Panel (ORHASP)a panel
of experts and local citizenswas appointed to direct and oversee the
Oak Ridge Health Studies and provide liaison with the community. Based on
the findings of the Oak Ridge Health Studies and what is generally known about
the health risks posed by exposures to various toxic chemicals and radioactive
substances, ORHASP concluded that past releases from ORR were likely to have
affected the health of some people. Two groups most likely to have been harmed
were (1) local children who drank milk produced by a "backyard" cow or goat
in the early 1950s and (2) fetuses of women who routinely ate fish from contaminated
creeks and rivers downstream of ORR in the 1950s and early 1960s. The Panel
made eight recommendations in their project summary report:

Three specific initiatives directed to public health intervention should
be undertaken:

In partnership with a local college or university, a series of workshops
should be periodically conducted for local physicians and other health professionals
who need to be educated on ORR environmental and occupational health issues
arising from the Oak Ridge Health Agreement Studies and other related health
studies, as results become available.

In partnership with a local community college or community outreach program,
a public information colloquium should be conducted to provide continuing dialogue
and education on environmental and occupational health issues relevant to past,
current, and future ORR operations.

A partnership working group of local, state, and federal public health officials,
health care professionals and representatives of the greater Oak Ridge community
should be established to evaluate the need for a formal clinical evaluation
process. If such a process is determined to be feasible, the group should formulate
recommendations for the development of (1) a goal for a formal community clinical
evaluation process; (2) the types of and qualifications for health care professionals
who would be involved in the clinical evaluations of concerned members of the
community; and (3) protocol guidelines for individual clinical evaluations and
referral for follow-up examinations. The group suggested that the results contained
in this report and the other reports published as part of the Oak Ridge Health
Agreement Studies serve as a basis for the development of such protocol guidelines.

Formal epidemiologic studies of populations exposed to iodine 131, mercury,
PCBs, and radionuclides from White Oak Creek are unlikely to be successful and
should not be performed at this time.

DOE, EPA, the state (and perhaps other agencies) should undertake a coordinated
program to obtain needed information and satisfy stakeholder concerns. A soil
sampling program is vital to gain information relevant to the historic contamination
levels in residential areas closest to the ORR plants. Detailed sampling is
recommended in all of the most closely situated neighborhoods and also in a
few residential areas at greater distances. Any decision about additional dose
reconstruction studies should be deferred until the results of the recommended
soil sampling program have been obtained and carefully interpreted.

DOE should undertake a program to measure the atmospheric dispersion of
controlled tracer releases from representative stacks and vents at Y-12. The
primary goal of these measurements would be to define the transport of a nondepositing
tracer such as SF6 from the Y-12 plant to populated areas of Oak Ridge, including
the Scarboro and Woodland communities, which are both relatively close to the
plant.

More definitive information is needed to better understand the potential
toxic effects of exposures to mixtures of contaminantsmercury and
PCBs, for exampleon the same organ systems. Studies relating to this
topic should be undertaken by one or more appropriate government-sponsored
public health research agencies.

DOE should take action to assure that copies of the important documents
used in the health effects studies are properly indexed and retained at a secure
location, irrespective of future shifts of contractor responsibility at the
ORR facilities.

DOE should assure the long-term continuation of the ORR environmental monitoring
program. The program should include routine measurements in critical media for
those materials found to be most important in the health agreement studies,
if the material in question could still be present in the local environment.
Specifically, the ORR program should (a) continue to monitor the remaining environmental
burden of mercury in EFPC within the Y-12 plant, in the lower EFPC floodplain,
and in sediment in the downstream watercourses, tracking the resulting methyl
mercury risk to consumers of fish taken from downstream fisheries; and (b) assure
that the program continues to monitor uranium contamination originating from
Y-12, with due consideration of isotopic form.

In the area of statewide health effects registries, (a) the state should
continue efforts to improve the accuracy and completeness of the cancer incidenceregistry, and (b) the state should continue to seek funding for a statewide
birth defects registry.

Feasibility of Epidemiologic Studies. A study was conducted to explore
the feasibility of initiating analytical epidemiological studies (for example,
case-control or cohort) to address potential health concerns in the off-site
populations surrounding the ORR. TDOH and the ORHASP contracted with a physician
from Vanderbilt University's Department of Preventive Medicine to conduct
the study. The study was released in July 1996. The study concluded that the
feasibility and desirability of initiating future analytical epidemiologic
studies would be significantly influenced by the findings of the dose reconstruction
studies which will clarify the extent and magnitude of releases and possible
human exposure from past releases of radioactive iodine, mercury, PCBs, uranium,
and other radionuclides, including cesium 137.

Public Meetings. Between January 1992 and December 1999, TDOH and ORHASP
held open meetings in Oak Ridge (more than 40 meetings), Nashville (5 meetings),
Harriman (2 meetings), and Knoxville (3 meetings). In addition, the ORHASP
held two meetings in the Scarboro area to update the residents on Phase II
of the Oak Ridge Health Studies. The first meeting was held at the Oak Valley
Baptist Church in November 1995, and the second meeting was held at the Scarboro
Community Center in September 1997.

II.F.3. Other Agencies

Aerial Radiological Surveys and ORR Off-site Background. DOE and its
predecessors on the ORR site and its immediate surroundings have performed aerial
radiological surveys since 1959 and through to 1997, with increasing sophistication,
as the methodology and detection capabilities have improved. Briefly, the present
methodology is to calibrate during flight the aircraft-mounted instruments against
a known radiation source, then survey the intended target area. The surveys
are carried out at a constant airspeed and altitude. Any detected radiation
sources are then investigated on the ground by standard survey techniques.

Around the ORR, including the Scarboro community, most of the "new"
radiation sources are single-contour anomalies that show no elevated ground
level readings. A single contour is defined as radiation that is limited in
its area; that is, only a spot of radiation with no additional radiation detected
at decreasing levels radiating from the central spot. If elevated readings within
this single contour are found, the source of the radiation is determined. By
this method, an inventory of known "off-site" radiation sources is
established and maintained. They are included as "regions of interest"
on the published radiation contour maps of the Oak Ridge area. They include
such locations as the Atomic City Auto Parts, the CXS Railroad bed, and others
related to past or current nuclear operations, as well as the Bull Run Steam
plant where flyash from operations is stored (Maurer 1989).

The Chattanooga shale outcroppings containing elevated concentrations of uranium
and its decay products occurring on East Fork Ridge and a few small cesium 137
deposits along the Clinch River during low water levels are both found by aerial
survey. The Clinch River deposits have been studied by TDEC/Oak Ridge Operations
(ORO) and deemed to be a non-hazard (Storms and Rector 1997).

Furthermore, the aerial surveys are sufficiently sensitive to detect sources
that do not constitute a hazard. By implication, the aerial surveys will readily
detect sources that do constitute a hazard. Except for a known few locations
due to past or present operations, the off-site areas of Bear Creek and Union
valleys, including residential areas of Oak Ridge, do not show any elevations
of radiation above background. Thus, there is direct empirical evidence that
the Union valley and Oak Ridge neighborhoods have not been contaminated.

Scarboro Community Health Investigation. In November 1997, a Nashville
newspaper published an article about illnesses among children living near the
nuclear weapons facility at the ORR in eastern Tennessee. The article described
a high rate of respiratory illness among residents of the nearby community of
Scarboro; it told of 16 children who had repeated episodes of "severe ear, nose,
throat, stomach, and respiratory illnesses." Among those respiratory illnesses
were asthma, bronchitis, sinusitis, allergic rhinitis, and otitis media. The
article implied that exposure to the ORR caused these illnesses especially given
the proximity of these children's residences to ORR facilities. In response
to this article, the Commissioner of the TDOH asked the CDC to work with the
department to investigate the situation in Scarboro. The Scarboro Community
Health Investigation, which included a community health survey and a follow-up
medical evaluation of children under 18 years of age, was coordinated by TDOH
to investigate a reported excess of respiratory illness among children in the
Scarboro community. This investigation, both the survey and the examination
components, was mainly designed to measure the rates of common respiratory illnesses
among children who reside in Scarboro, compare these rates with national rates,
and to determine if there were any unusual characteristics of these illnesses.
The investigation was not designed to find what caused the illnesses.

In 1998, a study protocol was developed and a community health survey was administered
to the members of each household in the community. The purpose of the survey
was to determine whether the rates of certain diseases were higher in Scarboro
than elsewhere in the United States and to determine whether exposure to various
factors increased residents' risk for health problems. In addition, information
regarding occupations, occupational exposures, and general health concerns was
collected for adults. The participation/response rate of the health investigation
survey was 83% (220/264 households) and included 119 questionnaires about children
living in these households and 358 questionnaires about adults. In September
1998, CDC released the preliminary results of the survey. The asthma rate was
13% among children in Scarboro, compared to national estimates of 7% among all
children aged 0-18 years and 9% among African-American children aged 0-18 years.
The Scarboro rate was, however, within the range of rates from 6% to 16% reported
in similar studies throughout the United States. The wheezing rate among children
in Scarboro was 35%, compared to international estimates that range from 1.6%
to 36.8%. With the exception of unvented gas stoves, no statistically significant
association was found between exposure to common environmental triggers of asthma
(that is, pests, environmental tobacco smoke, and the presence of dogs or cats
in the home) or potential occupational exposures (such as living with an adult
who works at the ORR or living with an adult who works with dust and fumes and
brings exposed clothes home for laundering), and asthma or wheezing illness.

Based on the information obtained in the health investigation survey, 36 children,
including those identified in the media report, were invited to receive a physical
examination. These examinations were conducted in November and December 1998
to confirm the results of the community survey, to determine whether children
with respiratory illnesses were getting the medical care they needed, and to
determine whether the children reported in the newspaper to have respiratory
medical problems really had these problems. Children who were invited to participate
met one or more conditions: (1) severe asthma, defined as more than 3 episodes
of wheezing or visiting an emergency room because of these symptoms; (2) severe
undiagnosed respiratory illness, defined as more than 3 episodes of wheezing
and visiting an emergency room because of these symptoms; (3) respiratory illness
and no regular source of medical care; or (4) identified as having respiratory
illness in newspaper reports. Of the 36 children invited, 23 participated in
the physical examination. Some of the eligible 36 children had moved out of
Scarboro; others either were not available or decided not to participate.

During the physical examination, nurses asked children who participated and
their parents a series of questions about the health of the child; volunteer
pediatricians reviewed the results of the nurse interview and examined the children.
In addition to direct physical examinations, children also underwent a blood
test and a special breathing test. If the examining doctor thought the child
needed an x-ray to complete the assessment, this was done. All examinations,
tests, and transportation to and from Knoxville were provided free of charge.

Immediately after the examinations, the results were reviewed and none of the
children had findings that needed immediate intervention. A number of laboratory
tests were found to be either above or below the normal range, such as blood
calcium level, blood hemoglobin level, or breathing test abnormality. Following
the initial review of results, laboratory results were communicated by letter
or telephone to the parents of the children and their doctors. If the parents
did not want the results sent to a doctor, the results were given to the parents
by telephone. The parents of children with any health concern identified as
a result of the examination were sent a personal letter from Paul Erwin, M.D.,
of the East Tennessee Regional Office of the TDOH, informing them of the need
for follow-up with their medical provider. If they did not have a medical provider,
they were to contact Brenda Vowell, RNC, Public Health Nurse, East Tennessee
Regional Office of the TDOH, for help in finding a provider and possible TennCare
or Children's Special Service.

In January 1999, a team of physicians representing CDC, TDOH, the Oak Ridge
medical community, and the Morehouse School of Medicine, thoroughly reviewed
the findings of the physical examinations and the community survey. Of the 23
children who were examined, 22 had evidence of some form of respiratory illness
(reported during the nurse interview or discovered during the doctor's examination).
Overall, the children appeared healthy and no problems that needed urgent management
were identified. Several children had mild respiratory illnesses at the time
of the examination; only one child had findings of an abnormality of the lungs
at the time of the examination. None of the children had wheezing. The examinations
did not indicate any unusual pattern of illness among children in Scarboro.
The illnesses that were detected were not more severe than would be expected
and were typical of those that might be found in any community. The findings
of examinations essentially confirmed the results of the community health survey.
The results of the review were presented on January 7, 1999, at a community
meeting in Scarboro. The final report was released in July 2000. A brief summarizing
this report is provided in Appendix I.

Three months after the letters went to the parents and physicians about the
findings, attempts were made to telephone the parents of children who participated.
Eight parents were successfully contacted. Because some of the parents had more
than one child who was examined, questions addressed the health of 14 children.
Parents of nine children could not be contacted despite attempts on several
days to contact them by telephone.

Of the 14 children whose parents had been contacted, 7 had seen a doctor since
the examinations. In most cases, the health of the child was the about the same,
although one child had been hospitalized because of asthma, and another child's
asthma medication had been increased to treat worsening asthma. Several children
had nasal allergies, and several parents mentioned difficulties in obtaining
medicines because of cost and lack of coverage by TennCare for the particular
medicines. Health department nurses subsequently have assisted these parents
in getting the needed medicines.

Scarboro Community Environmental Study. In 1998, soil, sediment, and
surface water were sampled in the Scarboro community to address community concerns
about environmental monitoring in the Scarboro neighborhood (see Figure 6 for
sample locations). The analytical component of the study was conducted by the
Environmental Sciences Institute at Florida Agricultural and Mechanical University
(FAMU) and its contractual partners at the Environmental Radioactivity Measurement
Facility at Florida State University and the Bureau of Laboratories of the Florida
Department of Environmental Protection, and by DOE subcontractors in the Neutron
Activation Analysis Group at the Oak Ridge National Laboratory. All samples
were analyzed for mercury, gross alpha/beta content, uranium, and gamma emitting
radionuclides. About 10% of the samples were also analyzed for target compound
list organics, target analyte list inorganics, strontium 90, uranium, thorium,
and plutonium.

Organic compounds were only detected in one of the samples tested. This same
sample also contained lead and zinc at concentrations twice as high as that
found in the Background Soil Characterization Project (DOE 1993). Mercury
was found within the range given in the Background Soil Characterization Project,
and about 10% of the soil samples showed evidence of enrichment in uranium 235.
The final Scarboro Community Environmental Study was released in September 22,
1998, during a Scarboro community meeting (FAMU 1998). A brief summarizing this
report is provided in Appendix I.

Scarboro Community Environmental Sampling Validation Study. In 2001,
EPA's Science and Ecosystem Division Enforcement Investigation Branch collected
soil, sediment, and surface water samples from the Scarboro community to respond
to community concerns, identify data gaps, and validate the sampling performed
by FAMU in 1998 (FAMU 1998) (see Figure 6 for sample locations). All samples
were subjected to a full analytical scan, including inorganic metals, volatile
organic compounds, semi-volatile organic compounds, radiochemicals, organochlorine
pesticides, and PCBs. In addition, EPA collected uranium core samples from two
locations in Scarboro and conducted a radiation walkover of the areas selected
for sampling to determine whether radiation existed above background levels.

The level of radiation was below background levels and the radionuclide analytical
values did not indicate a level of health concern. Uranium levels in the core
soil samples were also below background levels. EPA concluded that the results
support the sampling performed by FAMU in 1998, and that there is not an elevation
of chemical, metal, or radionuclides above a regulatory health level of concern.
The residents of Scarboro are not currently being exposed to harmful levels
of substances from the Y-12 plant. The report stated that "based on EPA's
results, the Scarboro community is safe. Therefore, additional sampling to determine
current exposure is not warranted." A final report was released in April
2003 (EPA 2003). A brief summarizing this report is provided in Appendix I.

1 The values from the Task 6 report were multiplied by 1.35 (70 years/52 years) for comparison with ATSDR's comparison values.2 Because this health assessment focuses on exposure
to uranium released from the Y-12 plant, the other main facilities on ORR are
not discussed in detail.